Stereotactic Radiotherapy for Brain metastases from 152 lung cancer patients

Abstract

Objective To assess the clinical efficacy and prognostic factors of Stereotactic Radiotherapy ( SRT) for patients with brain metastases ( BM) from lung cancer. Methods From March 1995 to July 2006, 152 consecutive patients with BM from lung cancer were treated by SRT, among them,59 patients received SRT alone, 40 patients received SRT plus whole brain radiotherapy ( SRT + WBRT) ,and 53 patients were salvaged by SRT after WBRT ( salvaged group). Log-rank method was used for univariate analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 97. 4％. The half year and 1 year local control rate for SRT alone group, SRT + WBRT group and salvage group were 96. 0％ and 93. 4％ , 94. 2％ and 90. 8％ ,81. 7％ and 77. 5％ ( X2 = 5. 39, P = 0. 068)respectively. The 1-,2-,5 year survival rate for SRT alone group, SRT +WBRT group and salvage group were 47. 4％ , 23. 7％ , 8. 5％ ; 55. 0％ , 20. 0％ , 0％ ; 41. 5％ , 7. 5％ , 1. 9％ , respectively. The median overall survival or each group was 11 , 12, 11 months ( X2 = 4. 08 , P = 0130) . The univariate analysis showed that the interval between diagnosis of lung cancer and BM, KPS, thoracic surgery, GPA grade, RPA class, system disease stable were significant prognostic factors ( X2 =11. 97, 5. 91 , 15. 48, 14. 48 , 15. 86,17. 36 , P = 0. 001 , 0. 015 , 0. 000 , 0. 000 , 0. 000 , 0.000) . The multivariate analysis showed that the RPA class , thoracic surgery were the independent prognostic factors ( X2 = 21. 02 , 8. 18 , P = 0. 000 ,0. 004) . KPS score less than 70, 80 ,90 for all patients before SRT and 3 months later after SRT were 48. 7％ , 33. 6％ ,17. 8％ and 27. 0％ , 46. 7％ , 26. 3％ respectively ( t = 7. 16, P = 0. 000 ) . Conclusions A definitive benefit of SRT in the treatment BM from lung cancer is observed; there is no difference of survival among SRT alone, SRT +WBRT and salvage treatment. SRT can improve the patients' KPS score. Thoracic surgery,RPA class were the independent prognostic factors for patients with BM from lung cancer. Key words: Neoplasm metastases,brain/radiotherapy; Radiotherapy,stereotactic; Radiotherapy,whole brain; Prognosis